The integrated psychopath

Today I was going to carry on with dissociative disorders, but in the end I decided to write about a topic I had never covered in these articles before: psychopathy. The DSM-5 doesn’t include it as a diagnosis in its own right: psychopathic traits are usually linked to the personality disorders, specifically to antisocial personality disorder, although not everyone with antisocial personality disorder is a psychopath (psychopathy is usually assessed with specific tools, such as the Hare checklist).

When we hear the word “psychopath”, most of us picture the horror-film stereotype, but we’re wrong. Those are extreme cases of psychopathy, and they’re the minority. There’s another kind of psychopathy that is far more common: the integrated psychopath (sometimes called the “successful” psychopath).

First things first: a psychopath (integrated and/or extreme) is both born and made. On the one hand, there’s an innate part: various studies have found that many people with this problem show differences in how certain brain structures work (the amygdala and the prefrontal cortex), so that for them the emotional world seems to be very different from that of the rest of the population. At the same time, highly conflictive environments in which the person suffers during childhood (abuse, mistreatment…) are also found in many cases.

Integrated psychopaths tend to be very intelligent, shrewd people. To the outside world they’re charming, diligent, decisive, strong-willed and highly independent, and they seem to have overwhelming self-assurance, confidence and self-esteem. In reality, though, their self-esteem is very fragile. They have a marked lack of emotional empathy, but they do have cognitive empathy. What does that mean? That they can’t, won’t and don’t know how to put themselves in your shoes or feel what you feel, but they are able to identify emotions cognitively, through logic, and know what the other person is feeling. And use that to their advantage. They use people to reach their goals: they “objectify” other human beings. In other words, they form relationships (including romantic ones) in order to achieve an end (prestige, sex, money, social standing…). Another human being is only worth something to them insofar as they serve as a means to an end.

A psychopath tends to feel very little fear or guilt; their nervous system seems to respond differently, because of how those brain structures I mentioned earlier work. If you barely empathise, it’s hard to feel guilt. If you barely feel fear, it’s hard to find limits. That’s why psychopaths find it so hard to respect limits.

Most of these people are men. While it’s true that female psychopaths exist, the proportion compared with men is much, much smaller. This applies to both extreme and integrated psychopaths.

Is a psychopath capable of love? Probably, but not by the standard the rest of us mortals use. Our idea of love (romantic, parental…) has nothing to do with theirs. They understand love in terms of possession and dominance. They use the “loved one” to get what they want, because they’re formidable manipulators. They’re the da Vinci of manipulation. True masters. They don’t know how to create intimacy with a partner; they confuse it with sex.

Someone like this is unlikely to take responsibility for their children or family either, because their emotional system doesn’t allow it: they don’t know how to, and can’t, form healthy emotional bonds with anyone. Their levels of self-centredness and selfishness tend to be so high that they think above all about their own needs and very little about anyone else’s. And if they seem to, it will usually be because they can get something out of the situation.

Can they change with therapy? It’s difficult. On the one hand, the way they function has a strong biological basis (although, as I said, the environment also plays a part); on the other, psychopaths tend to manipulate therapy and, if they do go, they usually drop out early. Even so, some studies suggest that certain intensive, specialised programmes, especially with young people, can reduce the most harmful behaviours, although the evidence is still limited.

When you read about this subject, the advice everywhere is clear: walk away, don’t get close to anyone like this, because they will seriously harm you. And it’s true.

We’ll come back to this topic to explore some of the particular features of the disorder.